1. Obtain verbal consent and perform hand hygiene:
Before beginning the procedure, a healthcare provider should ensure that verbal consent has been obtained from the patient, as well as performing hand hygiene to reduce the risk of cross-contamination. Hand hygiene must be performed before and after putting on gloves, in order to reduce spread of bacteria and other microorganisms.
2. Position patient in supine position with head of bed slightly elevated:
To optimize comfort, the patient should be positioned in a supine position with their head slightly elevated to allow for easy insertion and maneuvering of the NG tube. The healthcare provider should ensure that the patient remains still during insertion to reduce risk of accidental injury or misplacement of the tube.
3. Verify physician's order, tube size and appropriate equipment for correct placement:
The healthcare provider must review the physician's order for accuracy and verify that an appropriate-sized NG tube has been obtained for use based on age, weight, height and general health status of the patient. In addition, all necessary supplies should be checked prior to beginning the procedure to ensure that appropriate equipment is available for accurate placement of the tube.
4. Ensure the equipment is readily available, assembled and labeled appropriately:
A variety of supplies are required for successful insertion, including gloves, lubricant, tape or stabilization device and balloon syringe. Additionally, all items should be readily available in order to reduce any unnecessary delays in care. The NG tube should also be checked prior to insertion to ensure it is properly assembled and labeled with appropriate markings indicating size and length.
5. Cleanse the nares with an antiseptic solution or wipes according to facility protocol:
The nares must be cleaned with antiseptic solution or wipes prior to insertion of the NG tube in order to reduce the risk of infection. The healthcare provider should follow their facility protocol for performing this step, as well as any additional steps that may be required to reduce contamination.
6. Insert NG tube into nostril as far as it will comfortably go without resistance (measure insertion distance):
The NG tube should be inserted slowly and carefully into the nostril until resistance is encountered, at which point further advancement should cease in order to avoid trauma or misplacement. The healthcare provider should also measure the insertion distance from the tip of the nose to ensure accuracy of placement prior to inflating the balloon.
7. Secure NG tube in place using tape or stabilization device:
In order to prevent accidental dislodgement and minimize patient discomfort, the NG tube should be adequately secured in place using either tape or a stabilization device. The healthcare provider must ensure that the tape or stabilization device is applied properly and securely to reduce the risk of accidental misplacement or displacement of the tube.
8. Attach balloon syringe to end of NG tube:
Once the NG tube has been properly secured, a balloon syringe should be attached to the distal end of the tubing. This will allow for inflation of the balloon once placement has been confirmed.
9. Gradually inflate balloon until no air leakage occurs when pressure is applied:
The healthcare provider should gradually inflate the balloon with sterile water according to manufacturer's instructions until no air leakage occurs when pressure is applied to the tubing proximal to the balloon. This will provide confirmation of correct placement and prevent accidental displacement during care.
10. Confirm proper positioning by aspirating gastric contents through suction catheter attached to proximal open port of the tubing:
The healthcare provider should attach a suction catheter to the proximal open port of the NG tube and gently aspirate gastric contents in order to confirm proper positioning. If no gastric contents are returned, the placement should be considered unsuccessful and the procedure repeated with a new tube.